Ⅰ型糖尿病患者谷氨酸脱羧酶反应性T淋巴细胞与自身抗体的比较

Glutamic acid decarboxylase-reactive T cells and autoantihodies in type Ⅰ diabetes mellitus

应用NAG微量酶反应比色法反映细胞增殖，检测30例Ⅰ型糖尿病（Ⅰ型DM）患者外周血单个核细胞对谷氨酸脱羧酶（GAD）的反应性，并以Ⅱ型糖尿病（Ⅱ型DM）、其它自身免疫性疾病、正常人各30例作对照。同时应用间接ELISA法检测Ⅰ型DM患者血清中GAD自身抗体作比较。结果GAD反应性T淋巴细胞Ⅰ型DM的阳性率为36．7％（11／30），其它自身免疫性疾病10％（3／30），而Ⅱ型DM和正常对照组无一例阳性，Ⅰ型DM阳性率显著高于正常对照组（P＜0．005）。新发病Ⅰ型DM（病程≤1年）阳性率高达62．5％（10／16），与GAD抗体81．3％（13／16）的阳性率相比无显著性差异（P＞0．05）；长病程（1．5～20年）Ⅰ型DM的阳性率为7．1％（1／14），与正常对照组相比无显著性差异（P＞0．05），且明显低于GAD抗体64．3％的阳性率（P＜0．05）。这些结果表明新发病Ⅰ型DM存在GAD反应性T淋巴细胞，这对阐明Ⅰ型DM的发病机理，确定早期糖尿病的分型及指导治疗都有一定意义。

Glutamic acid decarboxylase(GAD) has been shown to be a target of autoantibodies in type I diabetes mellitus (type 1 DM). As pancreatic islet 5 cell destruction in type I DM is an autoimmune process mediated by T cells,we measured the proliferative resPonses to GAD of Peripheral blnd mononuclear cells from patients with type I DM, type I DM,other autoimmune disease and hea1thy controls.36. 7 % (1l/3o) of type l DM, lo% (3/3o) of other autoimmune disease and none of 3O tyPe' DM and 3o healthy controls responded to GAD. Very significant difference was observed between tyPe I DM and healthy controls(P <O. OO5). The prevalence of GAD-reactive T cells in newly diagnosed type I DM was 62. 5 % (lo/l6), which had no significant difference with that of GAD antibodies(P >o. O5). Only 7. 1 %(1/l4) of type I DM of longer duration responded to GAD, which was lower than the prevalence of GAD antibodies(P wtO. o5). These findings demonstrate that GAD-reactive T cells will be of value in the better understanding,early diagnosis and treatment of type I DM.